When it comes to surgery, your medical insurance or healthcare plan will only cover certain procedures. What can you do to cover those extra surgical needs that fall outside of the scope?
If you don’t have a specific healthcare surgery coverage plan, you may find yourself paying out of your own pocket. Most plans will cover you for a large amount of procedures. There are however several invasive, preventative or cosmetic surgeries that are not covered.
While each healthcare provider or insurance plan may differ on the details, here’s what is generally excluded by standard medical aids:
Cosmetic procedures are not covered. These include any aesthetic procedures that a patient will elect to undergo and are not medically necessary. They include face lifts, breast augmentation, rhinoplasty and more. Breast reduction is also currently classified as cosmetic, however there are current movements to amend this within the South African medical landscape.
2. Gastric bypass
Gastric bypass surgery or a “lap band” is generally not covered by a standard medical aid plan. Certain schemes are adding this procedure to their coverage list. In these cases, cover may include partial or full cover. Co-payments are usually required.
3. Dental surgeries
Dental surgeries that a patient chooses to undergo are more than likely not covered to any degree. These include any dental procedures classified as a lifestyle improvement versus medically required, such as implants and dentures.
4. Sex reassignment
Sex reassignment surgery is also currently classified as not medically necessary and is not covered by medical aid plans.
It’s important to confirm with your current medical healthcare insurance provider what preventative or invasive surgeries are or are not included, as different plans have different classifications for these categories.